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Applicability of heart failure clinical practice guidelines in low- and middle-income countries
Shelley Zieroth1, Clara Inés Saldarriaga Giraldo2, Fausto Pinto3
1Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Insights
Heart failure (HF) guidelines are not universally applicable, especially in low- and middle-income countries (LMIC). Clinicians in LMIC find HF guidelines less relevant due to a lack of consideration for local resource limitations, hindering effective patient care.
Area of Science:
- Cardiology
- Global Health
- Health Policy
Background:
- Clinical practice guidelines are often developed in high-income countries (HIC).
- Implementation of these guidelines in low- and middle-income countries (LMIC) may face significant challenges.
- Heart failure (HF) guidelines serve as a relevant case study for this issue.
Purpose of the Study:
- To assess the perceived applicability of current HF guidelines in LMIC.
- To identify barriers to implementing HF guidelines in diverse healthcare settings.
- To understand clinician perspectives on guideline relevance across different economic contexts.
Main Methods:
- An online survey was distributed to physicians treating HF patients globally.
- The survey collected data on demographics, clinical experience, and perceptions of HF guideline applicability.
- Responses from clinicians in HIC and LMIC were compared.
Main Results:
- Clinicians in LMIC reported lower applicability of HF guidelines compared to those in HIC.
- A majority of all respondents (75.3%) felt HF guidelines were primarily designed for HIC.
- Lack of consideration for local resources was the primary implementation barrier identified by LMIC clinicians.
Conclusions:
- Current HF guidelines are perceived as not broadly applicable worldwide.
- Local resource limitations are a critical, yet often overlooked, factor in guideline implementation in LMIC.
- Findings suggest a need for context-specific guideline development to improve global HF management and patient outcomes.
Aims:
Clinical practice guidelines are commonly written by professional societies in high-income countries (HIC) with limited anticipation of implementation obstacles in other environments. We used heart failure (HF) guidelines as a paradigm to examine this concern, by conducting a survey to understand clinicians' ability to implement HF guidelines and their perceptions of the current HF guideline applicability in low- and middle-income countries (LMIC).
Methods And Results:
An online survey of physicians in the database of the Translational Medicine Academy who treat HF patients was offered by email from 5 October to 27 November 2023, inquiring of participants' demographic information, experience, and views of HF guidelines as related to their practice. Of 2622 participating clinicians, 1592 partially completed, and an additional 1030 fully completed the survey. Participants were from 138 countries; 668 practiced in HIC, and 1954 in LMIC. Those from LMIC regarded HF guidelines to be less applicable in their country than did those from HIC (p = 0.0002). Of all those responding, 75.3% indicated that it was somewhat or mostly true that the HF guidelines were mostly applicable to HIC. Those from LMIC, but not HIC indicated that the greatest implementation obstacle was that the guidelines were for HIC (51.3% vs. 43.1%; p = 0.0387). A significantly higher proportion of respondents from LMIC indicated that resources for caring for their patients were somewhat or mostly limiting in most cases, than did those in HIC (41.6% vs. 32.5%, p = 0.0068).
Conclusion:
This survey examined the widely-held thought that HF guidelines are broadly applicable to all regions of the world, concluding that such a perception is incorrect. Clinicians from LMIC view the absence of consideration of local resource limitations as the greatest obstacle for guideline implementation. The results regarding HF guidelines likely also have implications for other guidelines and resultant patient outcomes.
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